Who’s who in a specialised Multi-Disciplinary Team?

During the life course of living with limb loss there might be occasions when you require the help of a specialised Multi-Disciplinary Team (MDT).

This could be because you have recently become an amputee or perhaps something significant has changed in your situation, such as needing revision or further surgery, or your goals and aspirations might have changed.

An MDT can also be useful when considering a significant change in prosthetic prescription, such as progressing to a more advanced prosthesis like a Microprocessor Controlled Knee (MPK). Whatever the reason, understanding who might be present, and what their role will be, can help with a potentially daunting situation…

Patient

As the patient, you will be at the centre of everything and should feel empowered to have your say. You may wish to have somebody with you when you attend an MDT meeting – a partner or spouse, for example, or an advocate such as your BSO or myself as BSO (Prosthetics).

The following members of an MDT are usually based in the rehabilitation service centre and have in-reach to the wards. You will no doubt have had dealings with some of them in your time. Not all Limb Centres have all this expertise on site permanently, and may bring in
specialist clinicians as required. In some areas, the term MDT is replaced with Inter-Disciplinary Team (IDT). Each Member of an MDT – including the patient – brings their own experience and knowledge.

Consultant in Rehabilitation Medicine

The consultant (who usually has a special interest in amputee rehabilitation) should be responsible for the overall clinical care of the patient, although it is appropriate for other team members to lead on specific areas of care. In the current NHS structure, the consultant physician is generally considered to be the most appropriate team leader.

Supporting medical staff may include an Associate Specialised Staff Grade Doctor or a Clinical Assistant for Service Provision, and a Specialised Registrar in Rehabilitation
Medicine undertaking training. Most MDT's will also have one, or several, trained Nurses on hand to assist with the various stages of rehabilitation.

Prosthetists

Prosthetists provide the best possible artificial limb for patients who have lost or were born  without a limb. All prosthetists are able to assess, diagnose, prescribe and provide appropriate prosthetic treatment. Designated prosthetists should manage or oversee the prosthetic care of patients with rarer types of limb loss, such as congenital limb deficiency or upper or multiple limb loss, in order to develop and maintain the specialised experience necessary to meet the needs of these patients.

Prosthetic Technicians 

Their main role is to manufacture the various types of prosthetic devices (prostheses) supplied by their specialist rehabilitation service centre. Technicians are supplied with a measurement sheet, body cast, body tracing or a job card by a prosthetist. The technician will then manufacture the required prosthesis using a wide range of materials including plastics, metals, leather, carbon fibre, and composite materials.

All of the prostheses manufactured are bespoke – designed specifically for each patient. Frequently, the technician will be involved in the design stage. Some of the manufacturing may be carried out at a central fabrication facility, but the technician will still be available to conduct repairs.

Physiotherapists

Specialist physiotherapists should be experienced in lower limb pre-prosthetic and prosthetic rehabilitation/gait re-education skills training, have a good understanding of prosthetics, be able to look after limb loss patients with complex problems, and be conversant with the evidence-based clinical guidelines produced by the British Association of Chartered Physiotherapy in Amputee Rehabilitation (BACPAR).

They should have skills in goal setting and use of outcome measures. They should also be able to liaise with, advise and educate the other MDT members in the referring (acute) and rehabilitating hospitals.

Occupational Therapists

They are responsible for prosthetic limb training for patients with upper limb amputation or congenital deficiencies, including training in one-handed activities where relevant. They also undertake training for activities of daily living for both upper and lower limb amputees, and arrange home or school visits in liaison with physiotherapists and community therapists.

A suitably experienced occupational therapist should be a member of the core clinical team at all specialised rehabilitation service centres. They should have undertaken training in tissue viability and wound management, and have a good understanding of prosthetics and amputee rehabilitation.

Rehabilitation Engineers

A Rehabilitation Engineer should be available to advise on technical matters related to the quality, maintenance, risk management, assessment and prescription (e.g. gait analysis), procurement and disposal of prosthetic devices. Rehabilitation Engineers can be either Clinical Scientists or Clinical Technologists.

Orthotists

While prosthetists create and fit artificial limbs, orthotists are responsible for correcting nerves, muscles and bones by using a range of aids. Within their Health and Care Professions Council registration they will be able to assess, diagnose, prescribe, and provide appropriate orthotic treatment.

Assistant Practitioner

Assistant Practitioners act under the guidance of a healthcare professional. The role is varied but can include washing and dressing, feeding, helping people to mobilise, toileting, and monitoring a patient by checking their temperature, pulse, breathing and weight.

Podiatrist

A podiatrist should be available, or appropriate links with local podiatric services must be established, particularly to provide care for the remaining foot in unilateral lower limb diabetic or dysvascular amputees.

Psychologist/Counsellor 

A counselling service must be provided by clinical counsellors who have experience of working in a rehabilitation setting. Although basic counselling will indirectly be provided by many members of the MDT, patients at all centres should have the option of seeing a qualified clinical counsellor. The counsellor should also be available to meet with relatives or carers of the amputee.

A clinical psychologist with experience in dealing with the particular issues of patients with physical disabilities should be available to see selected patients. Dieticians provide advice on nutrition to improve health, and aid in weight maintenance and healthy living.

Social Worker

A hospital social worker/care manager should be available to establish the appropriate links with Social Services, to identify any continuing healthcare needs, to give advice regarding benefits and other financial matters, and to be involved with plans for discharge
from the acute hospital.

Peer Group Volunteers

These are available on a part-time basis to talk with, and offer help to, any patients who are interested.

If you have a question or would like advice on any prosthetics issues, please contact Brian Chenier BSO (Prosthetics) at Blesma Chelmsford on 020 8548 7080 or at  bsoprosthetics@blesma.org